Uncovering Discrepancies in IV Vancomycin Infusion Records between Pump Logs and EHR Documentation

Area of Science:

• Pharmacokinetics and Pharmacodynamics
• Health Informatics
• Clinical Pharmacy Practice

Background:

• Accurate infusion timing is critical for vancomycin therapeutic drug monitoring (TDM), influencing area under the concentration-time curve (AUC) and trough levels.
• Current methods for assessing infusion time accuracy are resource-intensive and difficult to scale.
• Electronic health records (EHRs) may not accurately reflect actual drug administration events recorded by infusion pumps.

Purpose of the Study:

• To analyze timestamp discrepancies between EHR documentation and infusion pump event logs for vancomycin.
• To determine the prevalence of inaccurate infusion start times, completion times, and interruptions documented in EHRs.
• To highlight potential impacts on clinical decision-making for vancomycin therapy.

Main Methods:

• Utilized process mining techniques to compare EHR data with infusion pump event logs.
• Developed an algorithm to link pump event logs to corresponding EHR records for vancomycin infusions.
• Analyzed discrepancies in infusion start time, completion time, and interruption duration.

Main Results:

• Significant discrepancies were found in infusion start times (19.1% > ±10 minutes).
• A small percentage of infusion interruptions exceeded 20 minutes (2.5%).
• Completion time discrepancies were noted in a substantial portion of both 1-hour (24.2%) and 2-hour (32%) vancomycin infusions.

Conclusions:

• Infusion pump event logs and EHR data can be leveraged to study infusion administration time discrepancies at scale.
• Timestamp discrepancies are likely an inherent issue within current EHR documentation processes in hospitals.
• Further investigation across multiple institutions is recommended to understand the prevalence and guide improvement efforts.